Management of traumatic peripheral artery pseudoaneurysm:A 10-year experience at a single center

Purpose: This study aimed to report our 10-year experience with the management of iatrogenic(penetrating trauma) and traumatic(blunt or penetrating trauma) peripheral artery pseudoaneurysms, based on data from a tertiary referral center.Methods: From January 2012 to December 2021, the medical records of consecutive patients with iatrogenic and traumatic peripheral artery pseudoaneurysms were retrospectively reviewed. Patient demographics, clinical features, imaging data, treatment details, and follow-up results were analyzed.Results: Sixty-one consecutive patients were included in this study;48(79%) were men and 13(21%) women,with a mean age of 49.4 ± 13.4 years(range 24–73 years). There were 42 patients(69%) who underwent open surgery, 18(29%) undergoing endovascular embolization or stent implantation, and one(2%) undergoing ultrasound-guided thrombin injection. All patients successfully underwent open or interventional treatment. The median follow-up was 46.8 months(2.5–117.9 months), and the overall reintervention rate was 10%. Of these,one(5%) patient in the interventional treatment group and five(12%) patients in the open surgery group underwent reintervention. The overall complication rate was 8%, with complications occurring only in the open surgery group. No deaths occurred in the peri-operative period. No late complications, such as thrombosis or pseudoaneurysm recurrence, were observed.Conclusion: Peripheral artery pseudoaneurysms arising from iatrogenic or traumatic causes can be effectively treated by both open surgery and interventional procedures in selected patients with acceptable mid-and long-term outcomes.

Dynamic changes in liver function after transjugular intrahepatic portosystemic shunt in patients with cirrhosis

Purpose:To evaluate the dynamic changes in liver function after transjugular intrahepatic portosystemic shunt(TIPS)creation in patients with cirrhosis and to explore its association with clinical outcomes.Methods:This retrospective study included patients who underwent TIPS between August 2016 and December2020.Liver function was primarily evaluated using the model for end-stage liver disease(MELD)score,which was analyzed at baseline,1 week,1 month,3 months,6 months,and 12 months using one-way repeated measures ANOVA.The Kaplan-Meier method,log-rank test,and multivariate analysis were used as appropriate.Results:In total,235 patients were included in this study.The MELD score was significantly higher at 1 week(11.8±3.1 vs 13.5±3.5,p<0.05)and 1 month(11.8±3.1 vs 13.2±4.6,p<0.05)than the baseline level and recovered at 3 months(11.8±3.1 vs 11.9±3.9,p>0.05).At 12 months,the MELD score was higher than the baseline level(11.8±3.1 vs 12.4±3.2,p<0.05).Patients with a recovery of the MELD score(n=151)at 3 months had a lower probability of overt and severe HE(log-rank p=0.015 and p=0.027,respectively)than those without recovery(n=84).Logistic regression analysis revealed that albumin(odds ratio[OR],0.926;95%confidence interval[CI],0.863–0.992;p=0.029)and platelet count(OR,0.993;95%CI,0.987–0.999;p=0.033)were independent predictive factors for non-recovery of the MELD score at 3 months.Conclusions:Liver function after TIPS creation showed a trend of deterioration at first,followed by recovery.Recovery of liver function at three months was associated with reduced overt and severe HE.

Dual neovascular targets of vascular endothelial growth factor receptors and platelet-derived growth factor receptor ameliorate thioacetamide induced liver fibrosis in rats

Aims:Neovascularization plays a crucial role in liver fibrosis(LF),and blocking vascular endothelial growth factor receptors(VEGFR)has been shown to improve fibrosis.The aim of our study was to investigate the role of dual neovascularization targets,VEGFR,and platelet-derived growth factor receptor(PDGFR),in ameliorating fibrosis.Methods:In vitro,we observed the effects of apatinib(APA)(a VEGFR inhibitor)and donafenib(DON)(a VEGFR and PDGFR inhibitor)on the activation,proliferation,and apoptosis of hepatic stellate cells(HSCs)from rats and humans.In vivo,we established a thioacetamide(TAA)-induced liver fibrosis rat model to explore the antifibrosis effect of APA and DON.We used the method of random table to randomly divide the rats into 4 groups.We detected the expression of angiogenesis-related proteins using Western blot and immunohistochemistry.Results:APA and DON inhibited the proliferation and activation of HSCs,promoted apoptosis of HSCs,and arrested the S phase of the cell cycle in vitro.We also found that DON had a stronger inhibitory effect on HSCs.In vivo,APA and DON ameliorated liver fibrosis,reduced collagen deposition andα-SMA expression in rats,and DON had a stronger improvement effect.APA and DON downregulated the expression of VEGFR2 while inhibiting the phosphorylation of Akt and ERK1/2.DON can act through both VEGF and PDGF pathways,whereas APA can only act through the VEGF pathway.Conclusion:Antiangiogenesis is a promising approach for the treatment of fibrosis.Compared with a single-target drug(APA),the dual-target drug(DON)can achieve better therapeutic effects.

Management of non‐cirrhotic extrahepatic portal vein obstruction‐related portal hypertension in adult patients

To The Editor:Non‐cirrhotic extrahepatic portal vein obstruction(EHPVO)is a hepatic vascular disorder characterized by the obstruction of the extrahepatic portal vein with or without the involvement of the intrahepatic portal veins or the splenic or superior mesenteric vein in the absence of cirrhosis.1 In most cases,EHPVO leads to the development of portal cavernoma.EHPVO is commonly complicated with portal hypertension;in fact,a study revealed that 30%of patients with portal hypertension‐related variceal bleeding are ultimately diagnosed with EHPVO.In addition,EHPVO is the most common cause of upper gastrointestinal bleeding in children,accounting for approximately 70%of pediatric portal hypertension cases.